Sept 17 - 20, 2012
Boston, MA 

ACOEM

Worksite Wellness:

The Healthy Worker Advantage

October 6, 2012-Chicago 

Greetings! 

One of the perplexing issues that seems to come up from time-to-time is the exact definition of what constitutes an on-site clinic.  As a result, perhaps it's time for a review of the concept.  Actually, the provision of medical care at any level that is focused on the workforce could come under this heading.  However, we prefer to think of the dedicated workforce health initiative (by whatever it is called) as a program and not a place.  This means that we include not only "on-site," but also "near site" and "shared site" locations in our definition. 

These programs encompass wellness, prevention, intervention, medical care, and on-going therapeutics.  Some programs incorporate disease state management, dental, and employee assistance.  Convenience for the employees and their beneficiaries might dictate that pharmacy, radiology, and lab also be available.  In addition,  well-designed programs will likely articulate in some way with the local medical community.

In the end, however, the one common denominator is the specific involvement of the employer as the primary architect of the medical purchasing function.  The employer is buying health services on a direct basis rather than through any kind of vendor (typically, the insurer and its network of providers).  Historically, employers have always paid for the services, but they have seldom been involved in the direct purchasing process. The same can be said for the end consumer since they have traditionally had limited choices dictated by a profound lack of information, and generally speaking, they had to choose benefits from a network that was designed for a generic insurance pool.

The programs that we envision start with a consumer who has access to information about their care and their benefit program and an employer that has been directly involved in the intelligent construction of both.  Not just a clinic, but a collaboration to achieve a higher value in a confusing marketplace.

We placed a small article about the Choosing Wisely Campaign on our Web site about two weeks ago.  However, we should have picked up on this sooner, since it was announced in April of this year.  Sorry for the delay in getting the information out to all of you.

Helen Darling, the president of the National Business Group on Health, authored a commentary about this on the Institute of Medicine's site on August 10, and we wanted to make sure you got to read her comments, as well.

Ms. Darling notes in her opening paragraph "As politicians face the disturbing consequences of high health care costs on federal, state, and local budgets, the need to act will likely drive unwise decisions."  She goes on to say that "Typical responses to severe cost pressures, .  . . are blunt cuts that often affect the most vulnerable and those without political power."

This commentary, published just a few days before the announcement by Presidential candidate, Mitt Romney, of his new running mate, Paul Ryan, was very prescient.  And, with the selection of Paul Ryan, Romney has now pushed health care back into the spotlight.  Over the summer, interest in health care issues by the public has waxed and waned, with the Supreme Court decision on the Affordable Care Act filling the news, and then fading away.

The sustainable growth rate issues for Medicare are huge, millions have been uninsured or under-insured for some time, and yet at the national level nothing is happening.  It is business as usual in Congress, with little hope of improvement any time soon.  A voucher system, promoted by Ryan with block grants to the states for Medicaid, won't solve the problem.  The Affordable Care Act may help, but again, won't solve the problem long term.  Until everyone is invested in a solution, solving the problem is like trying to turn a Carnival cruise line ship with a couple of oars....not happening.

We truly believe that initiatives like the Choosing Wisely Campaign are critical pieces to a long-term fix.   And, we applaud the American Board of Internal Medicine Foundation for initiating it, along with many specialty medical societies.  In addition, Consumer Reports has joined the effort to "ensure that consumers and patients have access to key information about tests and services that are overused."  This is a powerful initiative that could be incorporated into your own HR wellness and health education efforts, much more easily done if you have an on-site clinic with providers who can explain the program, provide hand-outs, and answer questions.

With high deductible plans bringing the patient into the decision-making loop, on-site clinics focusing on the whole patient and managing the entire medical process with that patient with wellness programs and incentives that work, Choosing Wisely becomes yet another weapon against poor health decisions.  We encourage you to use it "wisely." 

The New York Times OP ED piece on BELLIN Health Care in Wisconsin is something that everyone should read.  It was a Sunday Times editorial which gives it about as much exposure as anyone could want.

The article is a short one and entitled "Health Care Where You Work." We profiled it on our companion Web site as soon as we saw it since it embodies so much of the philosophy that we think is important for employers to consider when choosing any approach to workforce health.

This is about a health system that is, first and foremost, a quality provider of care.  Secondly, they provide employer on-site services, and they emphasize access.  The article points out immediate access to care and robust primary care programming as important components of the Bellin services to employers (and their own employees).  These are the standards of any successful workplace program.  But they go on to stress clinical pathways and standards of care.

Bellin has trumped any number of other providers in the crowded Wisconsin landscape by simple blocking and tackling.  The fact that the NYT has highlighted this program as an innovator, and that it has documented significant savings from a number of employers, is a reason to clip this article and keep it close at hand.

In reviewing the material that comes across our desks, we think that the industry is approaching a mainstream moment.  I noted an article that says just that in MEDCITY.  It references the number of firms that are getting into the business of providing on-site care in the workplace.  I think they are missing the point - it is not about the number of firms, it is about the array of other disciplines that are recognizing that this trend is a movement and not a fad.

Hospitals, health systems, brokers, insurance companies, business coalitions, and others are now "on board" because they can no longer ignore the fact that self-funded enterprises see this as the one, best way to approach the health of their employed and covered population.  (Note:  It is only the best way when it is done well!)

In any case, to all of those who have been watching from the sidelines, come on in!  We need more innovation and more competitive choices.  The water is fine and the pool is deep.

Sincerely,

Mike La Penna